We classify teeth into groups: incisors for cutting, canines (“eye teeth”) for tearing, and premolars and molars for grinding. The tooth types all have their own specific functions. For patients, the knowledge of how these teeth come together in pairs to function or rest is very important, not only for the longevity of the restorations (fillings) being placed in the mouth but for the health of related structures affected by these functions, like the muscles, nerves, and joints.Besides gum infection and tooth decay, the most common cause of disease of the mouth is abnormal forces acting on the teeth. This is usually self-inflicted by habits like grinding and clenching. While the first two pathologies, gum infection and tooth decay, are relatively easier to diagnose and treat, abnormal forces leading to trauma to teeth is much more complicated to treat. Most importantly, it needs to be managed in a timely and effective manner.
We live in a stressful world today. Unlike many years ago, no longer is our stress limited to personal and domestic affairs only, but now includes international events also. I have seen that stress reflected in the mouths of my patients. When I look into people’s mouths and see worn-down, fractured teeth, I sometimes ask them, jokingly, “Do you chew rocks?” They reply: “No, but I have been stressed lately. I think I am grinding my teeth.”
For the patients who think they grind or clench their teeth (bruxism) because of stress, I want to clarify that stress is a contributing factor, not the underlying cause of that habit. Most patients know that worn-down, flat, or saucer-shaped depressions on the chewing surfaces of the teeth may be a sign of grinding or clenching. What they do not know is that their grinding or clenching is usually a symptom of an unhealthy bite or traumatic bite. What they also may not know is that a receding gum line and the notching of the teeth they see at the area of gum recession is not because of using a hard toothbrush or conducting overzealous brushing.
The notches which appear as grooves at the necks of the teeth, and which can become deep are called abfractions. They are symptomatic of a traumatic bite. Sometimes, these gum line erosions can be extra sensitive to hot, cold, or sweet or sour foods. Treatment must begin with correcting the cause. Then, to relieve the pain and sensitivity, the dentist may treat chemically or fill those grooves, depending on the severity or aesthetics. The condition is quite common and generally do not pose the risk of the patient losing the tooth.
It should be noted that not every time a patient visits the dentist the reason results from bad oral hygiene. As a matter of fact, patients should visit their dentist for a check-up at regular intervals. One important reason is because stress related bruxism is not due to dental neglect, and more importantly, the signs are usually insidious, in other words, you could be developing a serious condition without even being aware of its presence.
There are times when worn down teeth are not due to abnormal forces such as uneven teeth, grinding and clenching. Instead, some people would either have soft enamel (a defect during its formation) or they may be manifesting the effects of severe demineralisation as a result of excessive intake of acid foods and beverages.
Remember that each tooth is the weakest at its neck, where the root of the tooth begins and the crown narrows down. Abnormal forces applied to the teeth cause them to flex at the neck, which can produce fractures in that junction. These teeth if not treated are at risk of fracturing completely at the gum line if the abnormal forces are not controlled and the teeth are not strengthened (restored).